Pediatric Practice Final (Weeks 6-9)

Factors that contribute to hand development & function

Social/ Cultural factors, sensory (somatosensory functions, sensory integration, visual perception), and musculoskeletal integrity (scar/wounds, skin integrity, ROM, strength/ tone)

Hand skills to observe

Reach, grasp, carry, voluntary release, in-hand manipulation, and bilateral hand use

Birth- 6 mo grasp milestone

Reach and palmar grasp emerge

6-12 mo grasp milestone

Purposeful release, radial grasp, and pincer grasp

1-2 yrs grasp milestone

Bilateral coordination, beginning in-hand manipulation

2-4 yrs grasp milestone

Refinement of grasp, emerging hand dominance

4-6 yrs grasp milestone

Mature in-hand manipulation and efficient grasp patterns

6+ years grasp milestone

Consistent hand dominance and refined dexterity

Palmar grasp

Infancy, beginning object exploration

Raking grasp

7-8 mo, allows retrieval of small objects before refined thumb-finger opposition develops

Radial digital grasp

8-9 mo, improved precision with grasp

Inferior pincer grasp

8-9 mo, beginning precise object manipulation

Pincer grasp

10-12 mo, efficient small object manipulation and self-feeding

Three jaw chuck grasp

10-12 mo, beginning tool use (crayons, markers, etc)

Development of handedness

Occurs between 2-6 years. Demonstrating handedness before age 1 is typically a red flag

6 underlying components of handwriting

Upper extremity support, wrist stabilization, open and stable thumb web space, stable arches of the hand, radial-ulnar dissociation (separation of the 2 sides of the hand), precise in hand manipulation

Upper extremity support

Needed for handwriting because proximal stability allows for distal mobility

Wrist stabilization

Optimal wrist posture for precise finger movements in neutral with slight wrist extension. Wrist position influences position of joints of the digits and thumb

Open & stable web space

Allows for thumb and finger opposition

Arches of the hand

Grasp depends on the integrity of the mobile parts of the arches

Radial- ulnar dissociation

Required for precise movements. Allows for manipulation of objects/ in-hand manipulation

In-hand manipulation

Handwriting requires adjustment of an object in one hand after the grasp

Development of visual motor integration

3 mo- track toy while laying on back

6 mo- extends arm to reach for toy

9 mo- move towards and reaches for toy

12 mo- pick up and place objects

Development of handwriting

10-12 mo: scribbles

2 yrs: imitates horizontal, vertical and circular marks

4-5 yrs: copies cross, right oblique line, some letters and numbers, might write own name

5-6 yrs: copies triangle, prints own name, and copies most letters.

Measuring handwriting

Domains of handwriting, legibility, writing speed, ergonomic factors

Domains of handwriting

Near-point copying, far-point copying, writing dictated words, composition, writing alphabet

Legibility

Alignment, spacing, size, readability, letter formation

Writing speed

Number of words per minute

Ergonomic factors (handwriting)

Posture, UE stability, mobility, pencil grasp

Intervention for oculomotor skills

Flashlight tag, alphabet tracking, reading, mazes, connect dots, where's Waldo. Use of equipment such as mirror, distance, and spacing

Intervention for eye teaming

Consider laterality and bilateral coordination. Paper tearing, arrow chart, scissor skills, zoom ball, etc

What to observe when looking at occupational performance (with fm and vmi)

Handwriting, cutting, fasteners, drawing, keyboarding, crafts

What to look at when observing postural control

Trunk alignment, shoulder stability, ability to maintain upright posture, endurance during seated tasks

What to look at when observing hand dominance and bilateral coordination

consistent hand preference, crossing midline, stabilizing paper, coordinated two-handed tasks

What to look at when observing grasp and pencil control

Grasp pattern, web space, wrist position, pencil pressure, movement from fingers vs whole arm involvement

What to look at when observing in-hand manipulation

Finger to palm translation, simple/complex rotation when manipulating small objects

What to look at when observing dexterity and motor precision

Precision pinch, finger isolation, object manipulation, speed and accuracy during fine motor tasks

What to look at when observing VMI

Copying shapes, letter formation, spacing, alignment, coordination between visions and hand movements

What to look at when observing strength/ endurance (FM)

Signs of fatigue, reduced grip strength, complaints of tiredness, decreased quality over time, difficulty sustaining FM tasks

FOR for FM & VMI

Combination of approaches/ FOR. Could be sensory, motor learning, cognition, biomechanical, etc

Examples of biomechanical intervention for FM

Optimize positioning through seating/ chairs etc, improve joint stability, reduce the physical demands by using different equipment

Examples of motor learning intervention for FM

Lots of practice of the activity, task specific, repetition

Examples of sensorimotor intervention for FM

Tactile strategies like writing in shaving cream, increased prop with weighted pencils, raised lines on paper

Examples of cognitive intervention for FM

Individualized problem solving techniques

Examples of activities for poor wrist stability

Vertical writing, animal walks, using slant boards

Examples of activities for closed web space

Use tweezers, beading, lacing, etc

Examples of activities for reduced arch development

Tongs, building legos

Examples of activities for radial-ulnar dissociation

Use a lite bright, stickers, finger games, etc

Examples of activities for poor in-hand manipulation

Moving coins, rotating crayons, shifting beads

Handwriting intervention activities

Games for letter formation, using low tech adaptations like highlighters, ipad games, available curriculums, etc

ADL milestones 0-3 mo

Child latches during feeding, enjoys bath time, usually able to tolerate diaper changing without crying

ADL milestone 3-6 mo

Shows interest in food, opens mouth as food approaches

ADL milestone 7-9 mo

In a high chair, holds and drinks from a bottle, starts to loock at and reach for objects

ADL milestone 10-12 mo

Able to self calm in car, not fearful of tipping head back, can usually participate in dressing without becoming upset, sleep schedule

ADL milestone 13-18 mo

Holds and drinks from a cup

ADL milestone 2-3 years

Aware of sensations such as wet diaper

ADL milestone 4-5 years

Able to use utensils, tolerate different clothing, can drink from a cup and straw without dripping, can complete everyday tasks that have multiple steps

Steps of ADL performance

Obtains supplies, use supplies, and complete steps of task

Factors affecting ADL performance

Client factors/ performance skills, performance environments, social environments, culture, physical environments, and activity demands

Promotion/ creating approach to ADL intervention

Want to offer all children opportunity to engage in ADLs, often encompasses universal design, consulting, and team/ systems approach

Establishing/ Restore approach to ADL intervention

Look at biomechanics, motor control, cognition, and sensory processing. Select tasks to address area breakdown

Behavioral approach to ADL intervention

Cueing- physical gesture, pointing, visual cue, verbal direct cue, and vernal indirect cue

Chaining

A way to break down the steps of a task. Can start from top or bottom. Includes both forward and backward training

IADL approaches

Biomechanical, sensory integration, behavioral/cueing, adaption, and social emotional

Biomechanical IADL examples

Practicing spreading a condiment on break- considering physical limitations

Sensory integration IADL example

Provide time for heavy work- move the laundry basket at the start of the day

Behavioral IADL example

Visual cueing for packing a backpack

Adaptation IADL example

Changing the wallet for money management in the lunch room

Social emotional IADL example

Social story about taking care of a pet

Main goals of pediatric feeding therapy

Helping children to find their own motivation to eat and supporting parents to feed their children

Responsive feeding values

Autonomy, relationship, competence, intrinsic motivation, and holism. Involves parent noticing cues and baby responding

Positive feeding tilt

When a child leans forward indicating readiness

Pediatric feeding disorder

Impaired oral intake that is not age-appropriate. Associated with medical problems, nutritional problems, deficits in feeding skills, and psychosocial dysfunction

Avoidant/ Restrictive food intake disorder (AFRID)

Feeding disorder when individuals significantly limit volume or variety of foods they eat

Evaluation of feeding

Discuss concerns/ history, parent/ caregiver engages with child at meal, observation of child's behavior, oral motor and feeding skills, and acceptance patterns. Look at psychosocial factors, relationships, and family impact.

Characteristics of play

Suspension of reality, intrinsic motivation, spontaneous, internal locus of control

Developmental stages of play

Solitary play, onlooker play, parallel play, and cooperative play

DIR model

Family first approach that emphasizes honoring the individual differences and using them to guide play and treatment

Adaptations to play examples

Switches, supporting sitting for low tone, positioning baby, eye gaze technology, etc

Switch considerations

Posture simulation (what movement do they have?-elbow flexion, wrist flexion, etc) and optimal switch placement (should support consistency, be low effort, and tone friendly)

Potential goal areas for social participation

Environment, self-determination, self-advocacy, and social engagement